high alt ast 4 weeks into cycle - thoughts?

[bartman314]

i'm 4 weeks into my tren/mast/test cycle and just got bloods back.

everything is within expected ranges (for me) except for alt (107, 9-46) and ast (81, 10-35), which are ~20% higher than i usually run. i always run injectable only cycles and i'm currently running 150 mg tren a and 100 mg mast eod and 75 mg test cyp every 4 days. diet is clean at about 3500 cal/day 50p:25c:25f. i'm taking 1200 mg nac and 250 mg milk thistle/day.

i'm planning on a 10 week cycle.

thoughts?

[kelkel]

it's really not that bad. Double your NAC, lose the Milk Thistle and consider adding in TUDCA or UDCA.

[Mr.BB]

Dont you take accutane Bart?

Sorry but disagree from Kel here. Transaminases double of top of range would worry me and I would be all over this if it was me.


Also look at your diet. Too much protein or some strange supps and add stress to your liver.

[kelkel]

BB I didn't mean not to worry, just that I don't feel it's horrendous. And I always value / respect your opinion. Now get up to 4-5 times the range for longer periods of time and there's serious issues to be had. Think we were talking about a case like than in another thread recently.

[bartman314]

thanks for the inputs! and you're right bb i was on accutaine, which is a known liver antagonist. i've been off accutaine for 6 months, and that shouldn't be a contributor in this case.

ill look into both recommendations.

[kelkel]

Remember, many things can cause this. From your diet like BB said, to hypothyroidism, strenuous exercise, etc.

[kelkel]

Also, if really worried consider a GGT test as it distinguishes between elevations caused by exercise and actual damage, hepatitas, etc. I'm probably destroying the spelling but.... (gamma-glutamyltranspeptidase)

[Ashop]

Remember, many things can cause this. From your diet like BB said, to hypothyroidism, strenuous exercise, etc.

That is something that people need to keep in mind,,,another reason alcohol is a bad idea during a strong cycle.

[bartman314]

right... i'm alcohol free.

[Mr.BB]

BB I didn't mean not to worry, just that I don't feel it's horrendous. And I always value / respect your opinion. Now get up to 4-5 times the range for longer periods of time and there's serious issues to be had. Think we were talking about a case like than in another thread recently.

Kel I've learn so much from you, didnt mean to come up like you were wrong, just my opinion is that should be looked up. Also, I've had bloods with ALT even higher than Bart and was not really making much gains, not really any medical reviews here, just my anedoctal evidence/opinion, that liver health is important for sucessfull cycle (besides the obvious health concerns of course).

thanks for the inputs! and you're right bb i was on accutaine, which is a known liver antagonist. i've been off accutaine for 6 months, and that shouldn't be a contributor in this case.

ill look into both recommendations.

If you been off for 6 months it shouldnt really have an effect, is it the first time you check your liver after the accutane?

[kelkel]

Kel I've learn so much from you, didnt mean to come up like you were wrong, just my opinion is that should be looked up.

You did not at all. And I agree! I've got a study or an article somewhere that you'll find interesting regarding elevated values. When I find it I'll get it to you. You guys will find this chart interesting:

[bartman314]

wow! nothing like data, thanks kel. :-) happy scientist.

to answer bb's question, yes, this is my first liver assay post accutaine. i ran ~10% lower in each @ 2x40mg accutaine/day.

[Mr.BB]

You did not at all. And I agree! I've got a study or an article somewhere that you'll find interesting regarding elevated values. When I find it I'll get it to you. You guys will find this chart interesting:

Healthy debate here

Completely agree with the CK comment on the chart, not so much with the transaminases, unless they dont mean that 2-5 fold the top of range, but the normal for that person. Example, individual with normal ALT of 17ui/L, gets a 85ui/L after a marathon (5 fold). If they mean 5 fold the top of the range I disagree.

Heres an interesting article/interview (Copyright © 2007, Gastro-Hep Communications, Inc.):


Transaminase Levels and Vigorous ExerciseMonitoring Editor: Maria H. Sjogren, MD, MPH
Maria H. Sjogren, Director, Hepatology Research, Walter Reed Army Medical Center;


G&H Why are levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) monitored in patients with chronic liver disease?

MS Clinicians monitor transaminase enzymes because they are good markers of the inflammation that may impair liver function. When we see abnormal transami-nases, we think of liver disease. However, raised levels of transaminases do not discriminate amongst the various disease states. Once raised levels have been detected, it is necessary to pinpoint what is causing the abnormality.

G&H How are liver dysfunction and vigorous exercise both linked to raised transaminase levels?

MS Healthy individuals have normal levels of trans-aminase enzymes. Although the levels that constitute “normal” are currently under debate, most people who are healthy have levels that are recognizably within the normal range.

However, just as these markers do not discriminate among liver diseases, they do not discriminate among several different sources of inflammation. Thus, raised levels can be traced to muscular inflammation as well as hepatic inflammation. People who exercise heavily (eg, weight lifters, marathon runners, soldiers who perform heavy-duty labor) can have abnormal transaminase levels, as can those suffering muscular trauma, such as myocar-dial infarction or even surgery in which some muscles are cut. The normal repair process in these cases engenders inflammation and raises transaminase levels.

G&H Do ALT and AST react to hepatic and muscular inflammation similarly?

MS Basically, the reaction between the two is similar. Again, there is a ratio that in healthy individuals is considered normal. AST levels normally measure at approximately 0.8 of ALT levels. A dysregularity of this ratio can also signal hepatic illness but usually inflammation of any kind affects both measures.

G&H Can exercise-related elevations be correlated to individual incidences of exercise or muscle exertion, or do they build over time?

MS Publications on the subject have documented that once enzymes are abnormal, they remain abnormal for up to 1 week. Were subjects to exercise vigorously again during that week, transaminase levels could increase further. Some of the abnormalities have been noted as significant, particularly in marathon runners.

G&H Is it possible to raise transaminase levels with aerobic exercise, or does elevation only occur in conjunction with strength training or manual labor?

MS Strength training and very heavy manual labor are a much more likely cause of raised levels than aerobic exercise. Marathon running is an extreme form of aerobic exercise, but I would not classify it similarly. Although there are not many studies on aerobic exercise, shorter treadmill runs do not produce the abnormalities that occur in people who run 26 miles or more. Marathon runners have the potential to seriously damage their muscles through a process called rhabdomyolysis, which can raise transaminase levels significantly.

G&H Are exercise-induced levels of transaminases ever a cause for concern?

MS Concern would depend on the level of abnormality. In general, it is good for patients with liver disease to exercise, particularly those with fatty liver disease. In fact, we see a trend toward improved ALT and AST levels in patients performing moderate exercise, regardless of the etiology of their liver disease. We therefore discourage very heavy exercise in these patients, but a moderate amount does not cause a problem.

G&H What are the highest levels of transaminases that could be attributed to vigorous exercise? At what level should physicians begin looking for another cause?

MS We accept 1–2 times the upper limit of normal to be attributable to exercise or to certain medications such as cholesterol-lowering drugs. Beyond this level, there should definitely be concern of a clinically significant hepatic condition.

G&H What challenges do exercise-induced transaminase increases present to treating physicians?

MS Some physicians, whether they are gastroenterol-ogists or internists, forget that exercise can cause this abnormality. I have received referrals in the liver-disease clinic for a perfectly healthy person who happens to be exercising, whose history has not been taken or is not believed by the physician. This referral can lead to resources wasted on patients who have no illness and no other symptoms beyond these raised transaminase levels.

It is important to question patients about their exercise history, particularly if they have recently started a new regime. If a patient has just started lifting weights, there will be some associated muscle injury, as opposed to the ongoing conditioning of a regular exerciser.

Reference link: Transaminase Levels and Vigorous Exercise


Underlined the most important part for the debate here.

EDIT: Kel, from where was that chart taken from?

[kelkel]

Good stuff BB! I think it would be interesting to see how the levels would be after about two weeks of rest, without vigorous exercise. Re the chart I only copied the pic. I will try to find the original source. But in that vein, here's a relevant study that I know you'll find really interesting and it's on-point for this topic:

Muscular exercise can cause highly pathological liver function tests in healthy men

I just pulled BW this morning including CBC and CMP. Did a heavy leg session yesterday so I'll be curious how my numbers fare. They are usually a bit elevated. Normally I'd take the weekend off and get the BW on Monday a.m.

[Mr.BB]

Good find! If my conversions are correct some got their ALT up to around 240 ui/L, thats crazy but good to know.

I just got liver panel after a week off training and guess what?

[kelkel]

How much of a difference for you?



@ Bartman. Kinda feel we hijacked your thread. Sorry!

[Mr.BB]

ALT fluctuate between 50-80, hard to distinghish between heavy training and cycle.
With 20mgs accutane i got a reading of 140, and stopped it.

Also been on UDCA for over 6 months.

[kelkel]

ALT fluctuate between 50-80, hard to distinghish between heavy training and cycle.
With 20mgs accutane i got a reading of 140, and stopped it.

Also been on UDCA for over 6 months.

What dosage UDCA? I'm prescribed that myself.

[Mr.BB]

What dosage UDCA? I'm prescribed that myself.

Doc prescribed 500mgs before going to bed, it is for the gallstones.

For about 3 months I took another 500mgs in the morning, but it was getting expensive.

Therapeutical dosage is 10mg/kg.

[bartman314]

hijack is fine. i like to learn.